interstitial nephritis Flashcards

1
Q

what are tubulointerstitial disease ?

A

diseases affecting the tubules and the interstitial whilst sparing the glomerulus

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2
Q

is acute vs chronic interstitial nephritis reversible ?

A

yes , due to the preservation of basement membrane
chronic - there’s scarring and fibrosis and tubular atrophy

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3
Q

what are the causes of acute tubulointerstitial nephritis ?

A
allergic 
immune 
infections 
generally associated with progressive AKI after the introduction off a new drug
a type of hypersensitivity reaction
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4
Q

what are the clinical features of acute tubulointerstitial nephritis ?

A
rash 
fever 
eosinophilia 
elevated IgE
fanconi's syndrome 
patient may present with hematuria
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5
Q

what is fanconi’s syndrome ?

A

characterised by
glycosuria
aminoaciduria
phosphaturia
RTA

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6
Q

what does the renal biopsy in antibiotic induced acute tubulointerstitial nephritis show ?

A

shows eosinophils

occasionally ill defined granuloma

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7
Q

what lab changes may patients with NSAIDs induced interstitial nephritis present with ?

A

Nephrotic syndrome and massive proteinuria no eosinophilia and raised ALT

and have massive proteinuria with hypoalbuminemia

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8
Q

why is rifampicin induced interstitial nephritis different?

A

only ab that isn’t associated with eosinophilia

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9
Q

what are the lab investigation required ?

A

cbc with differentials
serum chemistry panel
urinalysis

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10
Q

what are the imaging investigations required ?

A

ultrasound , normal size kidney generally favors a diagnosis of acute kidney disease

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11
Q

what is the management for interstitial nephritis?

A

remove the causative agent
steroid therapy
treat any underlying disease along with supportive therapy

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12
Q

what is the regimen for giving steroid in AIN

A

methyprednisolone 1g/day day (initial pulse)
then prednisone 1 mg/kg for a period of time

predinsolone 1mg/kg for a period of time

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13
Q

what are the classification of interstitial nephritis ?

A

acute and chronic

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14
Q

what are the causes of chronic interstitial nephritis ?

A
toxins ( lead , analgesia )
infections 
metabolic 
autoimmune 
radiation
neoplastic infiltration 
hereditary renal disease
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15
Q

what other name is given to the chronic form of interstitial nephritis ?

A

chronic tubulointerstitial nephritis

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16
Q

what is the onset of chronic tubulointerstitial nephritis

A

insidious onset

17
Q

what is the most common category of chronic interstitial nephritis ?

A

analgesic nephropathy

18
Q

in its most severe form what is analgesic nephropathy associated with ?

A

papillary necrosis in addition to chronic interstitial nephritis

19
Q

what are the clincal findings of patients with analgesics nephropathy ?

A

renal insufficiency
modest proteinuria
sterile pyuria
anemia

20
Q

what can aid the diagnosis of analgesics nephropathy ?

A

history of heavy use of analgesics
microcalcifications of papillary tip seen on CT

on CT there is evidence of micro calcifications at the papillary tips

21
Q

what is sterile pyuria ?

A

presence of WBCs in the urine with no evidence of bacteria

22
Q

what may the intravenous urography show in obstructive uropathy?

A

hydronephrosis

23
Q

what is lead nephropathy commonly misdiagnosed as ?

A

hypertensive kidney disease

24
Q

what is the classic presentation with lead nephropathy ?

A

hyperurecemia

gout is common

25
what is the most common metabolic cause of nephropathy ?
hypercalcaemia
26
with what diseases can hypercalcaemia happen with ?
hyperparathyroidism multiple myeloma vitamin d intoxication
27
what is a complicating factor of hypercalcaemia ?
nephrocalcinosis | renal stone formation
28
what is the management of chronic interstitial nephritis ?
``` immunosuppressive therapy kidney transplant dialysis phosphate binders calcium supplement epogen ( for the anemia) ```
29
when should we consider using steroids in cases of AIN ?
if no improvement within 3-5 days ofd removing the offending drug
30
what are the findings of renal biopsy of kidneys with allergic response to NSAIDs ?
minimal change nephrosis along with changes associated with interstitial nephritis
31
What are the drugs known to cause ATN?
b lactams cephalosporins fluoroquinolones NSAIDs Diuretics Rifampicin Allopurinol PPI
32
What is the result of vesicoureteral reflux?
focal glomerulosclerosis with nephrotic syndrome
33
What kinds of stones are associated with urinary tract infections?
ammonium magnesium phosphate stones